Rape Prevention and Risk Reduction: Review of the Research Literature for Practitioners

For many professionals working in the field of sexual assault, one of the most pressing questions is: ""What can we do to prevent it?"" Practitioners have been designing and implementing rape prevention programs for decades, and researchers have been evaluating them for almost as long. The purpose of this article is to summarize the answers we have so far, because the good news is that we have learned some important lessons along the way regarding the prevention of adult and adolescent sexual assault. (The prevention of child sexual abuse will not be addressed in this article). For the purposes of this review, the terms ""rape"" and ""sexual assault"" will be used interchangeably.

However, it won't take long for many readers to realize that there are far more questions than answers. The second purpose of this article is to provide concrete guidance for practitioners on how to design, implement, and evaluate rape prevention programs in the real world where we don't have all the answers from research conducted so far.

In recent years, several resource materials have been published to provide guidance for researchers and practitioners on sexual violence prevention.

For example, the Centers for Disease Control and Prevention published a document in 2004 entitled Sexual Violence Prevention: Beginning the Dialogue.

Similarly, the National Sexual Violence Resource Center published Sexual Violence and the Spectrum of Prevention: Towards a Community Solution (Davis, Parks, & Cohen, 2006).

Both of these documents provide an overview for a comprehensive approach to prevention for practitioners, including detailed examples of interventions at various levels of influence (e.g., individual, interpersonal, community, societal). The CDC report also offers guidance for agencies to determine which components may best meet their organizational mission, goals, and resources. These documents can help practitioners to carefully think through their prevention strategy and understand where a particular intervention might fit within the larger picture. They can also help practitioners to identify specific goals for interventions that are targeted at different levels of influence and time points when prevention activities can occur. Many people believe that this type of an integrated approach is the most likely to create and sustain changes in broader societal norms.

A Comprehensive Approach to Prevention: Identifying a Target Audience

These resource materials can also assist practitioners in identifying their target audience for prevention programs, by determining whether interventions are universal, selected, or indicated. As summarized by Lee, Guy, Perry, Sniffen, and Mixson (2007):

""A universal strategy is one that targets an entire population without regard to their exposure to sexual violence, a selective strategy targets those who have a heightened risk of becoming a victim or perpetrator of sexual violence, and an indicated strategy targets those who are victims or perpetrators"" (p. 15-16, also citing CDC, 2004).

We will use these concepts later in this article as we provide an overview of existing programs, summarize what we know about their effectiveness, survey promising practices, and offer recommendations for improving their content and evaluation.

We thus begin our review of the research literature by focusing on prevention programs for men. It is certainly important to acknowledge the presence of male victims of sexual assault by both male and female perpetrators. However, because the vast majority of perpetrators of sexual violence are male, they clearly represent a key target for prevention efforts. In line with current practice, we will refer to programs that attempt to change the behavior of potential perpetrators (i.e., men) as ""rape prevention programs"" and programs focusing on victimization issues or rape avoidance as ""risk reduction programs."" Such terminology highlights the fact that true prevention can only take place by changing the behavior of men as the primary perpetrators of sexual assault; programs designed for women attempt to deter sexual assault by providing information that can reduce an individual's vulnerability.

Rape Prevention Programs for Men

Only a small percentage of rape education programs are designed specifically for men (8% in one comprehensive review by Morrison, Hardison, Mathew, & O'Neil, 2004). These programs often ""focus on men taking responsibility for their own behavior and methods to confront sexually coercive behaviors in others"" (Gidycz, Rich, & Marioni, 2002, p. 242). They often include a presentation and discussion, live or taped discussions of survivors, and behavioral interventions including interactive videos, guided imagery exercises, and/or theatrical vignettes (Gidycz et al., 2002).

Conclusions Regarding Impact

At this point, there is relatively little evaluation research conducted with men's programs. Yet review of this limited body of work suggests three conclusions that we will critically examine.

(2) Some programs have also reduced men's self-reported likelihood to rape (for reviews, see Berkowitz, 2002, 2004; Breitenbecher, 2000; Gidycz et al., 2002). This is an important variable to study because it ""is associated with rape supportive attitudes, sexual arousal in response to rape depictions, aggression toward female confederates in a laboratory situation, and a history of self-reported sexually aggressive behavior"" (Breitenbecher, 2000, p. 28).

(3) There is evidence to suggest that some prevention programs might reduce men's actual sexual aggression (Foshee et al., 2004; Foubert, Newberry, & Tatum, 2007; Linz, Fuson, & Donnerstein, 1990). Such findings are certainly promising, and this remains one of the most important research directions in this field. However, there are unique issues that must be considered when reviewing this body of research.

Challenges and Limitations

Evaluation research with rape prevention has been limited by the fact that very few studies measure men's behavioral sexual aggression. Rather, typical practice is to use other outcome measures thought to be precursors of sexual violence, such as rape supportive attitudes, beliefs about gender stereotypes, knowledge of rape-related information, and behavioral intentions to commit sexual assault. There is a relative lack of research documenting that these characteristics are predictive of sexual aggression (Gidycz et al., 2002).

Almost all of the research in this field is conducted with college students or other convenience samples. This includes low-risk groups and/or groups with limited diversity (see Morrison et al., 2004). The reasons for this are clear: college students are comparatively easy to reach with educational interventions. Although barriers certainly exist in a college setting, they are often considerably more pronounced when attempting to reach younger students or individuals in community groups or institutions. Other barriers may also be less significant for college students, such as the social stigma associated with the issue, knowledgeable personnel to implement the program/intervention, and no obligation to obtain parental consent as with younger students.

For all of these reasons, it is understandable that most prevention programs have been targeted toward college students. It must be stated in the clearest terms that virtually everything we know in the field of rape prevention is based on research that has been conducted with college students. The obvious concern is whether or not the research findings will generalize to other types of people. One of the most pressing needs in the field is thus to expand our efforts beyond schools and campuses into our wider communities and across age, gender, class, ability/disability, race/ethnicity, sexual orientation, etc. This need is difficult but not impossible to meet.

There are also conceptual questions about whether educational programs for college students constitute primary prevention at all, because they are not necessarily designed to prevent the first incident of sexual assault perpetration. Indeed, many people question whether sexual assault can be prevented among college students when the data suggest that first sexual experiences typically occur at a much younger age, that a notable percentage of these first experiences are forced, and that sexual and physical violence occur at alarming rates among middle school and secondary school students (Hickman, Jaycox, & Aronoff, 2004). Clearly, a notable percentage of college or university students already constitute a high risk group for whom the goal of educational programs is not primary prevention, but rather the prevention of repeated experiences of sexual assault victimization or perpetration. Unfortunately, we have largely failed to develop interventions specifically tailored for such high risk groups.

Rape prevention evaluation has been limited in its ability to detect meaningful change due to methodological factors and measurement issues (Gidycz et al., 2002; Morrison et al., 2004). The good news is that we have tools for accurate measurement; standardized measures exist to assess self-reported sexual aggression and victimization (e.g., the revised Sexual Experiences Survey , Koss et al., 2007).

For any practitioner designing an intervention, we strongly recommend consulting with a social scientist who is well versed in the issues of sexual violence and trained in the methodologies for conducting evaluation research and analysis. Options include working with a professor at a local college or and/or partnering with another organization to leverage resources and possibly expanding the sites for study.

Some authors caution against the typical strategy of evaluating program impact only in terms of group scores because this may make it difficult to see what is going on for various sub-groups of program participants. In other words, the question may not be whether a program works or doesn't work in a generalized way, but rather for whom a particular program is effective- and whether there are participants for whom it is ineffective, counterproductive, or even harmful. To explore this question, evaluation studies must examine not only specific outcomes but also additional variables that might influence a program's impact on individuals. Such variables might include gender, age, racial/ethnic identification, and risk factors for sexual assault perpetration or victimization (Breitenbecher, 2000; see also Foubert and Newberry, 2006; Heppner, Neville, Smith, Kivlighan, & Gershuny,1999; Schewe and O'Donohue, 1996). These risk factors could include previous trauma and victimization, rape myth acceptance, acceptance of interpersonal violence as a solution for problems, and other cultural beliefs and attitudes that appear to support male sexual violence against women (Heise, 1998). It could also include readiness to change, as measured by Banyard, Eckstein, and Moynihan (in press). Measurement should also be designed to detect negative effects, should they occur.

More detailed analysis is also needed to determine which program components are responsible for facilitating any positive changes that are seen (Morrison et al., 2004). The most important questions for evaluation research in this area may actually be: ""Which components of the programs are effective for which groups of participants?"" This issue is discussed in greater detail in a later section of the article.

Risk Reduction Programs for Women

A number of educational interventions have been designed for women-only audiences. These programs typically provide information about risk-reduction techniques, the impact of rape on victims, and local resources (Gidycz et al., 2002). Other types of risk reduction programs have also been developed by practitioners, including educational programs designed to prevent drug-facilitated sexual assault by warning women to ""watch their drink,"" etc. In fact, most rape crisis centers engage in some type of prevention programming (Campbell, Baker, & Mazurek, 1998), though research has not generally evaluated the outcomes of such community programs.

Self-Defense Training

The development of self-defense training for women has been based on evidence that active resistance strategies can deter the completion of an attempted sexual assault (for reviews of this literature, see Rozee & Koss, 2001; Ullman, 2007). As described by Ullman (2007), these active resistance strategies include:

On the other hand, nonforceful verbal resistance strategies (pleading, crying, reasoning) and not resisting (e.g., freezing) are not effective in reducing the likelihood of rape completion (Ullman, 2007). Based on this pattern of findings, some recent risk reduction programs for women have been designed to include information on resistance strategies, risky situations, and actual training in self-defense/resistance.

Evidence suggests that women's participation in risk reduction programs- particularly those including self-defense training- decreases their likelihood of being sexually assaulted in the future (for reviews, see Hanson & Broom, 2005; Ullman, 2007; see also more recent research by Orchowski, Gidycz, & Raffle, 2008). To illustrate, meta-analysis was conducted to explore the outcomes of five risk reduction programs for college women, with data combined from all five studies to increase the sample size and statistical power. The authors concluded that: ""Of the 918 women in the treatment groups, 20.3% reported being sexually victimized during follow-up compared to 24.5% among the 868 women in the control groups - a reduction of four sexual assaults for every 100 women attending the program"" (Hanson & Broom, 2005, p. 366).

Research also documents other positive outcomes resulting from self-defense training. As reviewed by Brecklin (2007), these include:

There is also some preliminary evidence to suggest that self-defense programs can decrease symptoms of Post Traumatic Stress Disorder (PTSD) and increase self-efficacy among those who have already been sexually assaulted (David, Simpson, & Cotton, 2006).

Limitations and Future Directions

Such findings suggest that self-defense training for women constitutes one of the most promising directions in the field of sexual assault prevention. Yet many of the same issues discussed in the context of men's programs also apply here. For example, few studies measure the outcome of subsequent sexual assault victimization; most rely instead on outcome measures tapping related beliefs, attitudes, intentions, and behaviors. Most research on women's programs is also conducted with college students or other convenience samples with limited diversity, and most post-testing is conducted immediately following program participation. Risk reduction programs for women (including self-defense training) are inherently limited by the fact that they do not necessarily constitute primary prevention. Nevertheless, their demonstrated efficacy suggests that they are an important part of an overall strategy for risk reduction.

Given the promise of risk reduction programs, Rozee and Koss (2001) have sought to provide guidance for future efforts by describing three stages of the resistance process in their AAA Model (Assess, Acknowledge, and Act). Within this model, the first stage of resistance is conceptualized as assessing the situation as potentially dangerous. The second is acknowledging that the situation is a potential rape, and the third is acting with active resistance strategies. Future research is needed to explore the question of whether such resistance strategies are equally effective for sexual assaults committed by a stranger, acquaintance, or intimate partner. However, it is reasonable to speculate that acknowledging a situation as dangerous is more difficult when the perpetrator is someone the victim knows or shares an intimate relationship with.

Yet the authors emphasize that active strategies do not guarantee successful resistance. In their words, they do not advocate an approach of teaching women to ""just say no,"" because most survivors say ""no"" and resist but are raped anyway (Rozee & Koss, 2001, p. 300). Rather, they suggest that programs seek to educate women on the early warning signs that are seen among many sexually aggressive men, as summarized in Rozee and Koss (2001): any behaviors indicating sexual entitlement, power and control, hostility and anger, and acceptance of interpersonal violence. Other risk markers among men can include impairment from alcohol or drug use, hypermasculinity and rigid gender roles, and male peer groups that glorify sexual conquest and even sexual violence (Heise, 1998).

Research suggests that ""women with assault histories are between one and a half to two times more likely to be sexually assaulted than are women without assault histories"" (Gidycz et al., 2002, p. 246). Women who have experienced past sexual assault victimization thus merit special consideration in the design of resistance training. This is true both because women with assault histories may experience a risk reduction program differently, and also because the impact of the program may be different.

For example, one study documented program impact only for those women who had not previously been raped (Hanson & Gidycz, 1993). However, this finding was not replicated in two other studies, which found no effect of program participation on women's subsequent sexual assault victimization, regardless of whether or not they had been sexually assaulted in the past (Breitenbecher & Gidycz, 1998; Breitenbecher & Scarce, 1999). Some evidence suggests that prior victims are more likely than other women to use passive resistance strategies and less likely to use active resistance strategies during a rape attempt (Norris, Nurius, & Mieff, 1996). Thus, women who have been raped in the past may require training that specifically addresses this issue and provides opportunities for them to plan and practice more active resistance strategies. This is a critical consideration that is often overlooked in the design and evaluation of programs.

In addition, many women who sign up for a self-defense course have been sexually assaulted in the past (30% in one study; see Follansbee, 1982). Some researchers have suggested that the line between treatment and prevention efforts may become blurred in the future as both develop over time (Gidycz et al., 2002).

To better evaluate risk reduction, future studies could include behavioral tests that measure a participant's ability to successfully implement specific resistance techniques (e.g., skills testing). Such behavioral observation would add to the existing knowledge of program impact which is exclusively demonstrated using various self-report measures. Beyond this rather obvious benefit, the information gained from behavioral testing also has the potential to provide more concrete guidance for the continuous improvement of resistance training programs.

Educational Programs: Single- and Mixed-Gender Formats

While we have sought to differentiate prevention programs for men from risk reduction programs for women, most rape education programs are actually designed for mixed-gender audiences (an estimated 64% of programs, based on the review conducted by Morrison et al., 2004). These programs include some combination of the following elements: (a) defining rape and sexual assault, (b) providing statistics on incidence and prevalence of sexual assault, (c) challenging sex-role stereotypes and prevailing rape myths, (d) discussing the effects of rape on victims, (e) explaining societal pressures and causes of rape, (f) discussing common attitudes and characteristics of victims and perpetrators, (g) promoting victim empathy, (h) teaching risk recognition, (i) identifying consent vs. coercion, (j) teaching safe dating behaviors, and (k) providing information about victim resources (Gidycz et al., 2002, p. 238). Most programs involve a lecture component, but often incorporate other methods as well, including videos, interactive drama, vignettes, and presentations by rape survivors (Gidycz et al., 2002).

Conclusions Regarding Impact

Such mixed-gender programs can be effective in changing rape-supportive beliefs and/or attitudes over the short-term (several months to a year), but they have generally not been successful in changing beliefs and attitudes over the long-term (for reviews, see Bachar & Koss, 2001; Brecklin & Forde, 2001; Breitenbecher, 2000; Gidycz et al., 2002; Morrison et al., 2004). The research also documents other positive effects of these educational programs (for reviews, see Anderson & Whiston, 2005; Breitenbecher, 2000). These include positive changes in rape-related knowledge , which can last for a period of time. However, changes are not generally seen for the variables of rape empathy or rape awareness behaviors--self-reported or observed behaviors that may reflect heightened awareness of rape, such as differences in dating behaviors or willingness to volunteer for rape prevention efforts (Anderson & Whiston, 2005); although there are exceptions. As with other programs, the impact of mixed-gender programs on actual sexual assault perpetration or victimization is not typically evaluated.

When reviewing the efficacy of educational programs, it is important to note that the research in this area has actually been quite mixed and most changes are seen immediately following program participation. Clearly, this evaluation strategy of immediate post-testing exerts powerful demands on participants to provide the ""right"" answers to outcome measures. This problem is exacerbated when a pre-test is used, because it trains participants in exactly how to provide the right answers. In fact, several studies have documented positive effects that are apparently due to pre-test assessment (i.e., sensitization effects), when scores of pre-tested participants are compared with those who were not exposed to a pre-test (for a review, see Breitenbecher, 2000).

To address this issue, a number of studies have taken steps to disguise the evaluation measures, such as by contacting participants later with a request or task that is ostensibly unrelated (see Breitenbecher, 2000 for a review). Examples include participating in a second research study that involves making rape-related judgments or calling participants to ask if they would be willing to volunteer time for a women's safety or rape prevention project. However, these studies have failed to provide consistent evidence of effectiveness.

Suggestions for Evaluation Research

Therefore, it is best not to use a pretest-posttest design with only a single group of participants. Without a control group of individuals who did not participate in the program, the findings from this type of research cannot be interpreted (Cook & Campbell, 1979). It is also best to avoid conducting any evaluation immediately following participation, because this does not provide a realistic indicator of program impact. While many people use this research design because it is comparatively cheap and easy, it is far better to allocate whatever resources exist toward a meaningful evaluation design, even if it must be modest in its scope.

To illustrate, randomly assigning participants to a program versus control condition eliminates the need for pretesting because the random assignment theoretically balances out various characteristics of participants in the two groups. Of course, this approach works better with a larger sample size, because any pre-existing difference between the two groups will take on greater significance if there are only a few individuals involved. Therefore, every effort should be made to increase the sample size whenever possible. Random assignment is also frequently challenging in the real world, because programs tend to be administered using intact groups (e.g., classes, sports teams, fraternities, sororities, dorm floors) rather than individuals who can be randomly assigned to one condition or the other. However, some researchers have simply assigned participants randomly to a condition within these intact groups. Another option is matching groups that receive the program with comparable groups that do not.

If pretesting is going to be used, it is critical that a control group of individuals not receiving the program be included in the study so their scores at both the pretest and posttest administration can be compared with those who participated in the program. It can also be challenging to create a control group of individuals who do not participate in the experimental program. However, this can often be handled by scheduling the administration of outcome measures before the control group actually participates in the program. Individuals in the control group will then get to participate in the program, they will just have to wait until after the outcome assessment.

Another possibility is to use different materials for the pretest versus posttest. Yet another suggestion is to pretest a sub-sample of the program and control groups and compare them with posttest scores from a different sub-sample of the two groups.

While these approaches may seem complicated, they are not that difficult to implement and they can avoid the serious limitations of an overly simplistic design. Every effort should be made to schedule the post-test assessment so it does not occur immediately following the program. Given the rebound effects that have been seen with outcomes of rape education programs, longer term follow-up is essential. Specific guidance for conducting evaluation research in real world settings is provided in the classic text on Quasi-Experimentation written by Cook and Campbell (1979).

On the basis of this review, we hope it is clear that prevention programs for men, risk reduction programs for women, and educational programs for both genders can yield a wide variety of positive outcomes. Experts are currently considering expanding the range of outcome measures that are assessed to better represent important short- and intermediate-term goals for sexual assault education programs. Examples include:

Increased knowledge of sexual assault dynamics and community resources;

Decreased self-report of actual perpetration behaviors, in addition to intentions;

Decreased experiences of sexual assault victimization;

Improved psychological well-being, including self-efficacy; and

Improved recovery and healing from the trauma of sexual assault victimization.

By expanding the tools we have available to examine a range of outcomes, we may find benefits of prevention programs that current evaluation measures have not detected. However, the selection of outcome measures must always be guided by the stated goals for the program. For example, if the program does not teach resistance strategies, there is little point to measuring the ability to execute them.

Experts are also pushing to expand our assessment of program outcomes beyond such individual-level variables to assess indicators at the levels of relationship, community, and society. Future studies with rape prevention programs could thus assess community-level variables such as the number of sexual assaults reported to authorities or the number of victims accessing counseling services or other resources. Yet such research must take into account the very low rates of reporting and help-seeking among sexual assault victims. This strategy thus presents a likely outcome for which prevention educators must be prepared: programming might actually make survivors more likely to come forward as the quality of the social safety net improves and community norms become more supportive for disclosures. This would likely result in a community seeing an overall increase in rates of reporting and help-seeking following educational efforts.

Bystander Education Programs

In recent years, one of the more promising directions in rape prevention is to focus on men and women as bystanders to change social norms in a peer culture that supports abusive behavior. A primary component of bystander education involves enhancing the responsibility of both men and women to intervene proactively in order to deter a potential sexual assault from being committed. One particular advantage of this approach is that it can be effectively implemented with mixed-sex audiences including both men and women.

When taking a bystander approach to prevention, audience members are addressed not as potential perpetrators or victims of sexual assault, but as third parties who have an important role to play. This approach may teach participants how to intervene reactively after a sexual assault, by supporting a friend or loved one who discloses victimization. Alternatively, programs can instruct participants how to intervene proactively by challenging friends who express sexist attitudes or provide guidance on ways to assist friends or others in risky situations (e.g., when a male friend is bragging about his sexual conquests in the locker room).

Most bystander programs address the full spectrum of potential intervention (before, during, and after an assault). These include the Mentors in Violence Prevention (MVP) Program (Katz, 2007; O'Brien, 2001) and the Bringing in the Bystander program developed by Banyard, Moynihan, and Plante (2007). Others are more specifically focused on reactive bystander training of supportive allies after an assault, such as The Men's Program (Foubert, 2000).

The hope is that these approaches overcome the natural tendency toward defensiveness, thereby increasing potential to effect positive changes. Proactive bystander education programs typically include discussions of very specific behavior, as well as general information about sexual assault, so bystanders are more aware of risky situations and can recognize problematic behavior. For example, program participants may be informed that risky situations frequently involve isolation and the use of drugs or alcohol. Participants may also be taught to identify the early warning signs that have been mentioned previously. Bystander intervention programs also frequently include role modeling exercises and opportunities to practice building bystander skills and efficacy; this type of strategy is recommended for adult learners.

Although promising, there is a limited amount of research demonstrating the efficacy of programs for both reactive and proactive bystander intervention. The few studies that have been conducted to date are encouraging (e.g., Banyard et al., 2007; Foubert & Perry, 2007; Schewe, 2006). For example, Banyard and colleagues evaluated their Bringing in the Bystander program and found that participants demonstrated significant positive changes on a range of outcomes, including sexual assault knowledge, rape myth acceptance, efficacy related to being an active bystander, and actual bystander behaviors. All changes persisted at the 2-month follow-up and many were still seen at a 4- and even 12-month follow-up (Banyard et al., 2007).

Media Facilitated Education

In the past, many people working in the sexual assault field have believed that the most significant impact of the media is its potential to raise awareness. Focusing media messages on raising awareness leaves behavior change to be effected by more interactive, in-person programs. Yet there are highly successful models in the public health literature for media campaigns that have achieved meaningful change in community norms, awareness, and even behavior (e.g., seatbelt use, smoking, drunk driving). Such programs can therefore provide a model for the field of rape prevention.

There are a variety of media facilitated programs for rape prevention (e.g., the MyStrength campaign, Red Flag Campaign, White Ribbon Campaign, Coaching Boys Into Men Campaign). However, these interventions have not generally been evaluated. This is partly due to the fact that evaluation methods for media interventions are complex and difficult to implement (for exceptions, please see Potter, Stapleton, Moynihan, & Banyard, in press; Potter, Stapleton, & Moynihan, 2008). It is therefore recommended that any such effort be undertaken in consultation with experts in fields such as social science, marketing, advertising, public health, public relations, and media communications. Although not always possible for individual practitioners, evaluation may be accomplished through social and organizational networking.

For More Information: For more information on the media campaigns mentioned here, please see the following websites: